Case Studies,

Chapter 15, Postpartum Adaptations

• You are caring for Linda, who has just delivered her first baby. You are responsible for assessing Linda’s condition during recovery and for doing patient teaching when the opportunity arises. (Learning Objectives 1 and 2)
• Gretta and Sam just had their first child. Gretta is excited and talkative about her birth experience and wants to keep her baby with her constantly. She tells you his name is Joseph and they will call him “Joey” for short. Gretta is breast-feeding and is attentive to Joey’s needs. You observe that Sam does not initiate contact with the baby but when Gretta insists that he hold Joey, he picks him up slowly and awkwardly and stares at his face for a long period of time. When Joey cries, he immediately returns him to Gretta’s arms. (Learning Objective 7)

1. While she is recovering, you keep checking her fundal height. Linda asks you how her uterus will go back to the way it was before she had the baby. How would you explain this physiologic process? What could impede the process?
2. Linda wants to know how long she should expect to bleed. What would you tell her?
3. The next day Linda appears very passive and you have overheard her telling everyone who will listen about her labor experience. What phase of adjustment is Linda going through? What other stages should she go through while adjusting to her new role?

• Based on your observations of Sam’s interactions with Joey, where is Sam developmentally in the process of paternal attachment and bonding?
• What nursing interventions could you implement that would assist Sam in the transition to fatherhood?

Case Studies,

Chapter 16, Nursing Management During the Postpartum Period

1. You are caring for Bonnie, age 42, who has just undergone a cesarean birth for her first baby. You are responsible for monitoring her condition during recovery and for teaching her how to take care of herself and her baby. (Learning Objectives 1, 2, 3, 4, and 7)

A. You note that Bonnie has a positive Homans’ sign in the left leg. What are the risk factors for thromboembolic disorders, and how will you determine if she has a DVT? If Bonnie has a DVT, what else is she at risk for?

B. Bonnie is ready for discharge and asks you about bleeding, perineal care, and what she should eat while breast-feeding. What are you going to teach her?

C. Bonnie, the baby, and Bonnie’s husband are following up for newborn care. What nursing interventions should be included to promote parental role adaptation and parent–newborn attachment?

2. You have just received report on the following patient. Hannah G1P1 gave birth vaginally 2 days ago to a baby girl. She had a midline episiotomy and has protruding hemorrhoids. Hannah is rubella negative and has A– blood type and her daughter is O+. Hannah is breast-feeding her daughter. Hannah is expected to be discharged to home later this afternoon. (Learning Objectives 5 and 7)

A. Describe the nursing management for Hannah and her family during the postpartum time period.

B. Hannah and Justin are preparing for discharge. What areas of health education are needed for discharge planning, home care, and follow-up visits for Hannah and her baby girl?

Case Studies,

Chapter 22, Nursing Management of the Postpartum Woman at Risk

1. Amy calls the office 3 days after delivering a healthy baby girl and tells you she is passing small clots and feels like her bleeding is heavier than it should be. You advise Amy to come into the clinic to be checked. (Learning Objectives 1, 2, 3, and 6)

1. What are the “four T’s” that need to be assessed in a possible case of postpartum hemorrhage?
2. Amy also tearfully tells you that she is experiencing anxiety and feelings of being overwhelmed. What is she experiencing, and what education are you going to provide?

2. Alyssa, age 26, had a cesarean delivery 7 days ago and is breast-feeding her baby. She calls the office today and reports that she has a temperature of 102. (Learning Objective 5)

1. Given the limited information you have, describe the four most likely types of infection Alyssa may have contracted.
2. What additional questions do you want to ask her to try to ascertain the cause of her fever?
3. Describe the care required to treat each of these infections.

 

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T.J. is a 76-year-old man that recently lost his wife. He lives alone now in an ALF where he has some friends that he associates with. They are “good for his overall well-being” claims the administrators of the facility who befriended T.J. when he lost his wife six months ago. The facility that T.J. lives in is convenient for many aspects of his life, including entertainment and even some of the healthcare associates from neighboring clinics that have partnered with the facility to allow visits with the residents.

Over the years, the associates from the neighboring clinic have grown close to some residents and have followed them during some of their crisis, both emotional and physical. Christine, a nurse practitioner from a neighboring clinic, has followed T.J. for many years and is now assessing his fall risk through a tool called the “Hendrick Fall Risk Tool II” a popular means of assessing the fall risk that may exist for an elderly person. 

An entry by the ARNP recently on T.J. demonstrated that there was enough information, recognizing previous and present knowledge to utilize the tool to give T.J. a score representing his fall risk. the entry reads: “T.J. is a 76-year-old that is evaluated today for his fall risk. He has a MedHx of BPH, COPD, seizures, eczema, and anxiety. He has been seen monthly and he described some episodes of nocturia that still persists. A list of his recent mediation includes Alprazolam, Phenytoin, Dutasteride, and ibuprofen prn. By administering the Get Up and Go Test, we find that he only had a brief episode of not being able to rise but he performed well after that completing it in 12 seconds. He demonstrates an improvement in his depression experienced in the past exhibited for several months after the loss of his spouse. His friends at the facility keep him busy and he is much improved in his outlook for the future.” C. Miller ARNP

Instructions:

1. Read the Fall Risk Assessment for Older Adults article.
2. Complete the Hendrich II Fall Risk Model tool form completely.
   • Assign the correct scores for the Fall Risk Tool.
   • Summarize the scores derived as per fall risk.
3. Develop a summary of the risks for T.J., so that the facility can respond to those risks and provide a safe environment.
4. Describe the level of safety that the facility should plan to give T.J.
5. Finally, explain whether you feel like the score from the Fall Risk Tool is accurate and if the tool is worth the effort to develop.
6. Your paper should be:
   • One (1) page or more.
   • Use factual information from the textbook and/or appropriate articles and websites.
   • Cite your sources – type references according to the APA Style Guide. Include at least 3 references no older than 5 years.

 

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Overview

For this discussion, first, review chapters 1, 2, and 4 in your textbook, Transcultural Concepts in Nursing Care. (https://books.google.com/books?id=XCWKCwAAQBAJ&pri…)

Then, address the following questions:

1. In your own words, in one short paragraph each, define each of the following and give an example from your practice (not a list!):
   1. Cultural baggage
   2. Ethnocentrism
   3. Cultural imposition
   4. Prejudice
   5. Discrimination
   6. Cultural congruence
2. Define cultural self-assessment and explain why it is important.
3. Then, describe the five steps in the process for delivering culturally congruent nursing care.

Your initial post must be posted before you can view and respond to colleagues, must contain minimum of two (2) references, in addition to examples from your personal experiences to augment the topic. The goal is to make your post interesting and engaging so others will want to read/respond to it. Synthesize and summarize from your resources in order to avoid the use of direct quotes, which can often be dry and boring. No direct quotes are allowed in the discussion board posts.

 

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How does Negligence and Malpractice Impact The Advance Practice Nurse?

Topic 1: The Legal Implications of Acceptance or Refusal of an Assignment

After reviewing the ANA position statement on “Rights of Registered Nurses when Considering a Patient Assignment,” discuss the legal and ethical implications of accepting assignments. When delegating assignments to unlicensed personnel, what considerations need to be considered? What insurance issues come into play? Analyze the legal principle of Respondeat Superior.

Topic 2: Defenses to Malpractice and Risk Management

Take the malpractice case assigned to your group and discuss the defenses that may be raised in that case. Discuss how the incident could have been prevented. What risk management techniques could have been used before and after the adverse patient occurrence? Respond to the other case scenario.

The Malpractice Case is as follows:

Facts: The plaintiff, Mrs. Carpenter, was a 55-year-old woman who underwent a total hip replacement at Caring Memorial Hospital. The physician was Richard Washington, MD. Dr. Washington is an orthopedic surgeon. His nurse practitioner is Judy Gouda, RN, NP. Dr. Washington reviewed the consent with Mrs. Carpenter prior to surgery. Joseph Alsoff, LPN, witnessed the consent and Mr. Carpenter was present. Joseph does not remember the doctor ever mentioning that death could be a result of the surgery. The recovery room nurse is Elizabeth Adelman, RN. The respiratory therapist is David Casler, LRT. The nurse on the post-surgical unit was Kelly Wheeler, RN. The supervising nurse was Mrs. Scale, RN, MS.

The patient had an epidural catheter for a post-operative pain management following an episode of hypotension in the recovery room which was treated with Ephedrine. Judy Gouda made rounds on the patient in the recovery room after the hypotensive event and vital signs were stable. The patient, Mrs. Carpenter, was placed on a medical surgical nursing unit with the epidural. The nurse, Kelly, was assigned to the patient and had not worked on that unit before, but had worked in post-acute critical care units. The nurse’s assignment was to provide patient care on the entire floor for that shift. There was also an LPN, Joseph, on the unit. It was a busy day on the unit. Mrs. Carpenter was not the only post-operative patient.

Kelly assessed the plaintiff upon admission, checked the IVs, asked if the patient was in pain, noted that the patient was responsive and understood where she was, and was stable. She then left to care for other patients.

The licensed practical nurse, Joseph Alcoff, had been working on the unit for several years. It had been rumored that Joseph was an alcoholic. There was no evidence that he had been drinking on the unit. Approximately an hour after the patient arrived on the unit, she was unable to tolerate respiratory therapy that was ordered and she became nauseated and vomited. David Casler administered the respiratory therapy. According to Kelly, the registered nurse, 10 minutes after the vomiting episode, Joseph Alcoff, the LPN, found the patient blue and unresponsive and called a code. Joseph is the only person other than the physician that carries his own liability insurance. The hospital also has malpractice insurance.

The code team responded, along with Kelly, the registered nurse. Mrs. Carpenter was intubated and cardiac resuscitation was initiated. The patient responded to resuscitative efforts and she was transferred to the intensive care unit. Subsequently, Mrs. Carpenter did not do well, was unresponsive, and declared brain dead and taken off the respirator. She did not have a DNR in place.

There is a conflict in testimony between Joseph the LPN and Kelly the RN. Joseph indicated that Kelly found the plaintiff to be unresponsive after the vomiting episode and called the code. The record is not clear as to when the vital signs and epidural site were assessed. Kelly said she did a motor and sensory level assessment and they were fine — it is not charted though. The time elapsed between the vomiting episode and finding the patient is in dispute. The final diagnosis was anoxia encephalopathy due to the time lapse between CPR being initiated. The patient was eventually extubated, breathed independently for a period of time, and then subsequently expired.

The vital signs ordered by the physician were hourly. The hypotensive episode in the recovery room had not been reported to the registered nurse.

The risk manager is Susan Post, JD, who works in collaboration with the quality assurance director Amy Green. Amy had noted when doing chart reviews over the last 3 months prior to this incident that the vital signs taken in the recovery room were not charted, not done, or not reported to the units. She was in the process of collecting data from the different units on this observation. She also noted a pattern of using float nurses to several postoperative units. Prior to this incident, the clinical nurse specialist, Michael Parks, RN, MS, CNS, was consulting with Susan Post and Amy Green about the status of staff education on these units and what types of resources and training was needed.

Reading

Textbook Readings

Essentials of Nursing Law and Ethics

• Chapter 5: “Defenses to Negligence or Malpractice”
• Chapter 6: “Prevention of Malpractice”
• Chapter 7: “Nurses as Witnesses”
• Chapter 8: “Professional Liability Insurance”
• Chapter 9: “Accepting or Refusing an Assignment/Patient Abandonment”
• Chapter 10: “Delegation to Unlicensed Assisted Personnel”
• Chapter 37: “Staffing Issues and Floating”

Journal Readings

Please retrieve and read the following journal articles. Articles can be located through a search in the CINAHL database, OVID databases in the library.

American Nurses Association Nursing World. (2016). Patient safety: Rights of registered nurses when considering a patient assignment. Retrieved from

American Nurses Association Nursing World. (2009). Patient safety: Rights of registered nurses when considering a patient assignment. Retrieved fromhttp://www.nursingworld.org/MainMenuCategories/Policy-Advocacy/Positions-and-Resolutions/ANAPositionStatements/Position -Statements-Alphabetically/Patient-Safety-Rights-of-Registered-Nurses-When-Considering-a-Patient-Assignment.html

Anselmi, K. K. (2012). Nurses’ personal liability vs. employers’ vicarious liability. MEDSURG Nursing, 21(1), 45–48.

Web Resources

• Reference in APA format

 

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